A three-dimensional finite element stress analysis for tunnel placement and buttons in anterior cruciate ligament reconstructions

Au, Anthony G.; Raso, V.J.; Liggins, A.B.; Otto, David; Amirfazli, Alidad

doi:10.1016/j.jbiomech.2004.05.007

Cited by 30 publications

(28 citation statements)

References 20 publications

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“…Klein et al [15] have classified morphologic changes and also defined four subtypes. In finite element analysis, most of the tension stresses were found at posterolateral side of tunnel walls, where Au et al [2] expected sclerotic changes according to Wolf's law. In our study, these sclerotic changes were observed in 86% patients of group A and 65% patients of group B.…”

Section: Discussionmentioning

confidence: 99%

“…The effects of dilation of tunnels on the strength of hamstring graft fixation using interference screws were evaluated in two different cadaver studies. The investigators yielded in both studies significantly higher graft pull-out values for the dilated tibial specimens than for the reamed specimens with mechanical testing [1][2][3]. Rittmeister et al's study [21] concluded that the benefit of dilators was related to a better match of tunnel and graft size, than achieving good bone quality.…”

Section: Discussionmentioning

confidence: 99%

“…Compaction drilling is another technique to constitute bone tunnels, which also has advantages in increasing insertion torque and pullout strength of interference screws [1][2][3]. We hypothesed that a compaction of the tunnel by using dilators could create an increased bone mass along the inner surface of the tunnel, and may decrease the risk of tunnel enlargement.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

Gökçe

Beyzadeoğlu

Ozyer

et al. 2008

International Orthopaedics (SICOT)

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The aim of this study was to investigate effects of bone impaction technique on tunnel enlargement after ACL reconstruction at a minimum 2 years follow-up. Two groups of patients who had been operated upon with the same arthroscopic technique with the exception of tibial tunnel constitution were compared. Twenty-one patients of group A (drilling to 6 mm followed enlargement to 8-9 mm by using dilators) and 23 patients of group B (directly drilling to the size of the graft) were evaluated clinically and radiographically based on multislice computerised tomography (MSCT) retrospectively. At follow-up, there was no statistical difference between tunnel diameters between two groups at the femoral site, but significant difference at the tibial site (p= 0.00192 for coronal; p=0.0171 for sagittal diameter). Both groups were comparable according pre-and postoperative Lysholm and IKDC scores (p<0.5 Mann-Whitney U test). Compacted tunnel walls may resist enlargement, suggesting this technique resulted in better tunnel diameter values especially with intratunnel fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

Gökçe

Beyzadeoğlu

Ozyer

et al. 2008

International Orthopaedics (SICOT)

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show abstract

“…It can facilitate the comparison between the intact knee and post-operative knee. In the previous studies, stress distribution was used to estimate the post-operative mechanical effect [10,11]. However, the stress near the tunnel aperture is much lower than those in the tibial condyles, and the stress redistribution near the tunnel aperture would be submerged in a general stress distribution.…”

Section: Discussionmentioning

confidence: 99%

“…Tunnel creation could cause local stress reduction and concentration adjacent to the tunnel wall [11,12]. According to the Wolff's law, a low bone stress may trigger bone resorption, and an overloading bone stress may cause micro-damage [13].…”

mentioning

confidence: 99%

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction

Yao

Wen

Zhang

et al. 2014

International Orthopaedics (SICOT)

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Purpose The tibial drill-guide angle in anterior cruciate ligament (ACL) reconstruction influences the tunnel placement and grafttunnel force, and is potentially associated with post-operative tunnel widening. This study aimed to examine the effect of the drill-guide angle on the stress redistribution at the tibial tunnel aperture after anatomic single-bundle ACL reconstruction. Methods A validated finite element model of human knee joint was used. The tibial tunnel with drill-guide angle ranging from 30°to 75°was investigated. The post-operative stress redistribution in tibia under the compressive, valgus, rotational and complex loadings was analysed.Results Compressive loading played a leading role on the stress redistribution at intra-articular tibial tunnel aperture. After ACL reconstruction, stress concentration occurred in the anterior and posterior regions of tunnel aperture while stress reduction occurred in the lateral and posteromedial regions under the compressive loading. Stress redistribution was partially alleviated by using the drill-guide angle ranging from 55°to 65°. Conclusions The present study quantified the effect of bone tunnel drill-guide angle on the post-operative stress redistribution. This phenomenon potentially contributed to tunnel widening. A tunnel drill-guide angle ranging from 55°to 65°was proposed based on the biomechanical rationale. It could serve as a helpful surgical guide for ACL reconstruction.

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Influence of bone adaptation on tendon‐to‐bone healing in bone tunnel after anterior cruciate ligament reconstruction in a rabbit model

Wen

Qin

Lee

et al. 2009

Journal Orthopaedic Research

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Anterior cruciate ligament (ACL) reconstruction with placement of grafted tendon in bone tunnel is a common surgical procedure. Bone tunnel creation may result in stress shielding of postero-lateral regions of tibial tunnel. The present study was designed to characterize the changes of peri-graft bone and compare with tendon-to-bone (T-B) healing in spatial and temporal manners after ACL reconstruction in rabbit. Surgical reconstruction using digital extensor tendon in bone tunnel was performed on 48 rabbits. Twelve rabbits were sacrificed at 0, 2, 6, and 12 weeks postoperatively for radiological and histological examinations. Bone mass and microarchitecture at the anterior, posterior, medial, and lateral regions of tunnel wall at distal femur and proximal tibia were evaluated. Using peripheral quantitative computed tomography, a 26, 22, and 42% decrease in bone mineral density (BMD) relative to baseline was present in the medial region of the femoral tunnel and the posterior and lateral regions of the tibial tunnel, respectively, at week 12 postoperatively (p < 0.05). It was accompanied by a decrease in trabecular number and increase in trabecular spacing, the shift of platelike to rodlike trabeculae, and loss of anisotropy under micro-computed tomography evaluation. This finding was echoed by histology showing increased osteoclastic activities and poor T-B healing in these regions. In conclusion, the postoperative bone loss and associated poor T-B healing was regiondependent, which may result from adaptive changes after tunnel creation. ß

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A three-dimensional finite element stress analysis for tunnel placement and buttons in anterior cruciate ligament reconstructions

Cited by 30 publications

References 20 publications

Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

Does bone impaction technique reduce tunnel enlargement in ACL reconstruction?

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction

Influence of bone adaptation on tendon‐to‐bone healing in bone tunnel after anterior cruciate ligament reconstruction in a rabbit model

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